Risk of Myocardial Infarction in Patients with Psoriasis and Psoriatic Arthritis: A Nationwide Cohort Study

Abstract

Psoriasis has been associated with increased risk of myocardial infarction (MI) in some, but not all, studies. This study investigated the risk of MI in patients with psoriasis and psoriatic arthritis in Denmark. All residents aged ≥18 years from 1 January 2008 through 31 December 2012 were included. Adjusted hazard ratios (HRs) did not show an increased risk of MI in patients with mild psoriasis (HR 1.02; 95% confidence interval (95% CI) 0.96-1.09), whereas the risk was slightly increased in patients with severe psoriasis (HR 1.21; 1.07-1.37). Stratified by age, there was no increased risk of MI in any specific age group, regardless of severity. Limited to first-time MI, the risk was increased only in patients with severe psoriasis aged<50 years (HR 1.52; 1.03-2.25). The same applied to patients without psoriatic arthritis (severe psoriasis aged <50 years; HR 1.74; 1.11-2.72). In analyses restricted to patients with psoriatic arthritis, age-specific strata did not show any association between psoriatic arthritis and MI risk.

Psoriasis and cardiovascular disease risk factors: the HUNT Study, Norway

“…Similar to the present study, cross‐sectional data from Germany showed psoriasis to be associated with type 2 diabetes and myocardial infarction, but reported no association with hypertension, metabolic syndrome, angina pectoris or peripheral artery disease . Also within the same cohorts, separate studies report conflicting results where psoriasis is either related to an increased risk of myocardial infarction or not …”

“…Systemic inflammation in psoriasis is put forward as an explanation of these associations, and aggressive screening of patients with psoriasis has been suggested . Study results are, however, not conclusive, and several population‐based studies show weak or no association between psoriasis and cardiovascular comorbidities . In addition, several of these studies are based on data from hospital registries, speciality clinics or visits to a general practitioner, where psoriasis patients are at increased risk of being screened for other diseases which thus might lead to detection bias .…”

“…In addition, several of these studies are based on data from hospital registries, speciality clinics or visits to a general practitioner, where psoriasis patients are at increased risk of being screened for other diseases which thus might lead to detection bias . Information on possible confounders associated with both psoriasis and cardiovascular disease, such as body mass index (BMI), smoking and socio‐economy is also sparse . Most published studies are based on diagnostic codes and do not have information on actually measured values of cardiovascular disease risk factors.…”

“…12 Study results are, however, not conclusive, and several populationbased studies show weak or no association between psoriasis and cardiovascular comorbidities. [13][14][15][16] In addition, several of these studies are based on data from hospital registries, speciality clinics or visits to a general practitioner, where psoriasis patients are at increased risk of being screened for other diseases which thus might lead to detection bias. 17 Information on possible confounders associated with both psoriasis and cardiovascular disease, such as body mass index (BMI), 18,19 smoking and socioeconomy is also sparse.…”

The relationship between duration of psoriasis, vascular inflammation, and cardiovascular events

“…Similar to rheumatoid arthritis, 13 most but not all studies have associated psoriasis with an increased risk of CVD, 2–5, 14–16 yet data suggest that classical CV risk factors alone do not fully capture this heightened risk, and systemic inflammation has been put forward as a potential explanation for the link between psoriasis and CVD. Along this line, inflammation is associated with impaired insulin sensitivity, carotid intima-media thickening, endothelial dysfunction, aortic stiffness, vascular inflammation, and coronary plaque burden and such CVD markers occur more frequently in patients with psoriasis.…”